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How to encourage health innovations and make sure that new medicines, vaccines, or diagnostics will reach every person who needs them? That is a question which has been hotly debated in different fora. Yesterday, the World Trade Organization, UN World Health Organization, and UN World Intellectual Property Organization jointly held a symposium on how innovative technologies can promote the United Nations Sustainable Development Goals. The WHO director general called on his colleagues to support policies facilitating access to health technologies.

The three Geneva agencies organised a trilateral symposium on 26 February to examine how innovative technologies can promote health-related UN Sustainable Development Goals.

This is the seventh such symposium organised by the three institutions on the intersection of public health, trade, and intellectual property.

In an unusual fashion, WHO Director General Tedros Adhanom Ghebreyesus (Dr Tedros) – who hosted the event at WHO this year – invited his two colleagues, WIPO Director General Francis Gurry, and WTO Director General Roberto Azevêdo for a pre-trilateral meeting dialogue, slightly delaying the start of the symposium.

The three directors general agreed to strengthen their partnership, to take it to a higher level, Dr Tedros said, and will ask their senior staff to identify concrete areas of cooperation.

Each director general gave remarks, with Dr Tedros focusing on access, Gurry on the complexities of the innovation system, and Azevêdo on WTO’s efforts on trade and access.

Dr Tedros: Health before IP, Transparency Needed

On intellectual property, Dr Tedros said in his speech, “We must not tolerate systems that put the protection of intellectual property ahead of the protection of health. Patients must always come before patents.” He also said that the lack of access to health technologies is rarely due to a single reason.

Access to medicines, diagnostics, vaccines, medical devices, and assistive technologies is a key pillar of universal health coverage, he said, remarking on the rising burden of non-communicable diseases and the equally rising financial burden of long-term treatment.

Beyond patented medicines, off-patent medicines also remain unaffordable for some, he said, adding that this is no longer an issue only for low-and middle-income countries.

Dr Tedros underlined the role of international trade agreements, which have the power to increase access but also can potentially delay the availability of generics by extending patent monopolies.

“Health is a fundamental and universal human right,” he said. “Better health allows children to learn and adults to earn.”

Dr Tedros said greater transparency is needed on prices and research and development costs. New business models need to be found that “strike a balance between fair profits and public health priorities.” Middle-income countries should have greater negotiating power, he said.

“It’s frankly ridiculous that some drugs cost more in middle-income countries than they do in high-income countries with larger markets and more bargaining power,” he said.

Dr Tedros mentioned the WHO Fair Pricing initiative, aiming at increasing transparency of prices and R&D costs, as well as procurement so that countries can negotiate better. He also underlined WHO’s efforts to ensure greater transparency in clinical trials, and the fact that in 2016, 21 of the world’s largest research funders signed the WHO statement on public disclosure of results from clinical trials.

And he said that the WHO is helping to shape the R&D agenda through initiatives such as the Global Antibiotic Research & Development Partnership, the WHO R&D Blueprint and the Coalition for Epidemic Preparedness Innovations.

The private sector has an important role to play, he said, adding that he started discussions with the private sector on how to scale up access to innovative technologies.

WTO, WIPO Asked to Support Access Policies

Dr Tedros highlighted three issues that the symposium would be able to advance. The first is the question of the affordability of medicines.

Second, he said good trade practices can be a valuable asset in promoting access to health technologies, and achieving universal health coverage. “We look to our friends at WTO for leadership in promoting trade rules” promoting such good trade practices.

And finally, he underlined the practice of evergreening patents as “a perfect example of corporate interests being put ahead of public health.” He noted that in some countries, patents for medical products are reviewed by health regulators, and said “we are interested to hear from our friends at WIPO whether this is a model which could be strengthened and expended.”

Innovation and Access Not Foes, Gurry Says

WIPO Director General Francis Gurry said health innovation and trade are inextricably connected and mutually dependent.

Massive challenges in public health, including antimicrobial resistance, non-communicable diseases, emerging diseases, and neglected tropical diseases, require new advances in medical technologies, Gurry said. These needed innovations require an economically sustainable basis, which historically has been provided either by the “public purse or the market system,” he said.

Gurry noted the dichotomy between the humanitarian imperative of public health, and economic rationalism. In a globalised world, this opposition plays out on the international stage, where innovations need to flow across borders to needy populations, he said. Historically, only two mechanisms have been used to that effect, he said: publicly and privately funded organisations, and on the other hand market basis and trade. This leads to “extremely complex” policy considerations, involving systems whose rationales are very different, he explained.

Those systems are not incompatible but they involve tensions, “likely to be of an enduring nature,” according to Gurry.

“The innovation ecosystem is extremely complex and increasing costly, but is also the  focus economic strategy and competition,” he said. He remarked on the unprecedented prominence of non-state actors, “unimaginable 20 years ago,” and on the impending transformations of global health and trading systems.

Gurry said the SDGs recognise the complexity of the matter, and separated health in SDG Goal 3, and innovation in SDG Goal 9, though the 2030 agenda recognises that the SDGs are integrated and indivisible.

He mentioned WIPO Re:Search, which deals with upstream innovation, and aims at accelerating discovery areas for neglected tropical diseases, and through which 120 collaborations have been achieved. He also mentioned Pat-INFORMED, an initiative with pharmaceutical companies through which those companies are providing legal status data on patents. This information is particularly useful for procurement agencies to determine the legal status of any medicine  (IPW, WIPO, 3 October 2017).

Azevêdo: Support Needed for Micro and Small Enterprises

WTO Director General Roberto Azevêdo, underlined the role of trade in poverty reduction. Trade’s contribution to the SDGs bears on different specific targets, on which WTO has started to deliver, including zero hunger and agricultural export subsidies, he said.

Target 3.b of SDG Goal 3 mentions the need to provide access to affordable essential medicines and vaccines, in accordance with the WTO Doha Declaration on TRIPS [Agreement on Trade-Related Aspects of Intellectual Property Rights] and Public Health, and the use of flexibilities within TRIPS. Azevêdo said the WTO “has taken major steps in delivering this target.”

He cited the decision by WTO members to extend the least-developed countries’ exemption of enforcement obligations of  intellectual property rights until “at least 2033” (IPW, WTO/TRIPS, 6 November 2015). He also cited the entry into force of the public health amendment of the TRIPS agreement (IPW, WTO/TRIPS, 23 January 2017). He said the WTO secretariat “is now actively working with members to ensure that the mechanism functions as a practical procurement tool.”

“There is no scope for complacency,” he said, as major public health burdens remain, and there is a lack of incentives for addressing certain health issues, in particular those affecting the poorest countries. “This means exploring new innovation models and this is a very important part of our trilateral work,” said Azevêdo.

“Innovation without access does not help to address the problems we are discussing here today,” he said.

The three organisations along with other stakeholders “share a responsibility to address these challenges so that innovative technologies come to the market, in affordable, sustainable and accessible form,” he said.

Azevêdo underlined the importance of supporting micro and small and medium-sized enterprises (MSMEs) since many new medical technologies come from start-ups. The MSMEs should find the support to develop their R&D activities in the international trading system, and to manage the related IP effectively, “bearing in mind ultimately that the public interest in the effective availability of their innovative technologies is the main goal.”

Azevêdo said WTO members launched an informal work programme on MSMEs at the December Buenos Aires Ministerial Conference, and added that the WTO’s Government Procurement Agreement could provide useful guidance to put in place a well-functioning procurement regime.

“Every country relies on imports, to some extent, for its access to medicines and their ingredients. Trade costs and delays unfortunately hit those countries hardest who are least able to absorb these barriers to access to medicines,” he said, adding that the implementation of the WTO’s Agreement on Trade Facilitation should help with access to medicines in developing countries.